Healthcare Provider Details

I. General information

NPI: 1083784979
Provider Name (Legal Business Name): LOUCAS-KARNOUPAKIS ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 04/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 RIDGE AVE
NEW CUMBERLAND WV
26047-0518
US

IV. Provider business mailing address

PO BOX 198
CHESTER WV
26034-0198
US

V. Phone/Fax

Practice location:
  • Phone: 304-564-3272
  • Fax: 304-564-3276
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberMP0550810
License Number StateWV

VIII. Authorized Official

Name: JIM KARNOUPAKIS
Title or Position: OWNER
Credential:
Phone: 304-387-2731